Information Technology Strategy 2009 - 2011 · Author: Sarah Hill Page 5 of 26 The Royal Bournemouth & Christchurch Version: 1.4 Hospitals NHS Foundation Trust Date: 15th May 2009

Information Technology Strategy

2009 - 2011

Approval Committee

Version Issue Date Review Date Document Author

Board of Directors

1.4 15th May 2009 March 2011 Sarah Hill

Author: Sarah Hill Page 2 of 26 The Royal Bournemouth & Christchurch Version: 1.4 Hospitals NHS Foundation Trust Date: 15th May 2009

CONTENTS 1.0 EXECUTIVE SUMMARY............................................................................................................. 4 2.0 INTRODUCTION ....................................................................................................................... 4

Vision.......................................................................................................................................................................................................4 3.0 BASELINE............................................................................................................................... 5

IT Services Department...........................................................................................................................................................................5 Systems Management .....................................................................................................................................................................5 Network and PC Support.................................................................................................................................................................5 IT Projects.........................................................................................................................................................................................5 Application Support and Data Quality ...........................................................................................................................................5 IT Training.........................................................................................................................................................................................5

Resources ...............................................................................................................................................................................................6 IT Infrastructure .......................................................................................................................................................................................6 IT Systems...............................................................................................................................................................................................6 Factors for Change..................................................................................................................................................................................7 National Programme for IT (NPfIT) and the NHS Care Record Service (NCRS)....................................................................................8 IT Steering Group....................................................................................................................................................................................8 Dorset Informatics Board.........................................................................................................................................................................9 Informatics Planning................................................................................................................................................................................9

4.0 REVIEW OF 2007 – 2009 PROJECTS........................................................................................ 9 Accident & Emergency Management and Clinical System .....................................................................................................................9 eIDF (Electronic Immediate Discharge Form) .......................................................................................................................................10 18 Week Wait ........................................................................................................................................................................................10 Care Pathways ......................................................................................................................................................................................11 Management Information System .........................................................................................................................................................11 Scanning of Medical Casenotes............................................................................................................................................................11 Digital Dictation / Speech Recognition ..................................................................................................................................................11 Telemedicine for Stroke.........................................................................................................................................................................12 N3 COIN................................................................................................................................................................................................12

5.0 SECURITY AND BUSINESS CONTINUITY .................................................................................. 13 Security and Virus Control.....................................................................................................................................................................13 Removable Media encryption ................................................................................................................................................................14 Data Centre ...........................................................................................................................................................................................14 Windows Servers...................................................................................................................................................................................14 Unix Servers ..........................................................................................................................................................................................15 Disaster Recovery .................................................................................................................................................................................15

6.0 IT DEVELOPMENTS ............................................................................................................... 15 Clinical ...................................................................................................................................................................................................15

Electronic Prescribing / Medicines Management .......................................................................................................................15 Chemotherapy Prescribing ...........................................................................................................................................................16 Cancer Information System ..........................................................................................................................................................16 Inpatient Tool for Clinicians..........................................................................................................................................................16 Pathology System Replacement...................................................................................................................................................16 Orthodontic System Replacement ...............................................................................................................................................17 Clinical Outcome Data ...................................................................................................................................................................17 Clinical Viewer Links .....................................................................................................................................................................17 Maternity System ...........................................................................................................................................................................17

Business Process..................................................................................................................................................................................17 Radiology Information System (RIS)............................................................................................................................................17

Administrative........................................................................................................................................................................................18 Website Re-Design.........................................................................................................................................................................18 Web Site Accessibility ...................................................................................................................................................................18 Content Management.....................................................................................................................................................................18 Use of mobile devices and email messaging ..............................................................................................................................18 Self Service Information Kiosks ...................................................................................................................................................18 eCaMIS Theatre System ................................................................................................................................................................18 eTCI (eCaMIS To Come In) ............................................................................................................................................................18 Customer Relationship Management (CRM) ...............................................................................................................................18 Single Assessment Process .........................................................................................................................................................18 eLearning ........................................................................................................................................................................................18 Document Storage / Scanning Solution for Non Patient Documents .......................................................................................18 Office 2007 ......................................................................................................................................................................................18 eCaMIS / Tomcat link for Cardiology Activity Data.....................................................................................................................18 eCaMIS / Diabetic link for Co-Morbidity Data ..............................................................................................................................18

The Infrastructure ..................................................................................................................................................................................18 Radio Frequency Identification (RFID).........................................................................................................................................18 Wireless Local Area Network........................................................................................................................................................18 Voice over IP (VoIP) .......................................................................................................................................................................18

National Requirements ..........................................................................................................................................................................18 Summary Care Record System ....................................................................................................................................................18

GP Developments .................................................................................................................................................................................18 Web Clinical Viewer .......................................................................................................................................................................18 Picture Archiving System (PACS) Viewer ...................................................................................................................................18 Electronic Transfer of Letters .......................................................................................................................................................18


Order Communications .................................................................................................................................................................18 7.0 FUTURE DEVELOPMENT POSSIBILITIES.................................................................................. 18

Main CaMIS / eCaMIS Server ...............................................................................................................................................................18 PACS Review........................................................................................................................................................................................18

8.0 RISKS................................................................................................................................... 18 Ascribe...................................................................................................................................................................................................18 NHS Care Record System.....................................................................................................................................................................18 IT Department Skills and Knowledge ....................................................................................................................................................18

9.0 SUMMARY............................................................................................................................. 18 10.0 RECOMMENDATIONS ............................................................................................................. 18


1.0 EXECUTIVE SUMMARY This document is the Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust’s (RBCHFT) Information Technology (IT) Strategy for the period 2009- 2011. The ability to exploit IT has never been greater with the requirement to drive for greater efficiency. The RBCHFT has been highly successful in releasing the potential of healthcare IT for many years and is well placed to invest further in seeking greater benefits. The IT Strategy has been produced through a consultation process involving a broad cross section of the Trust, including Clinical Directors of each specialty and members of the IT Steering Group and is consistent with meeting the challenges set out in the National Informatics Plan, the South West Informatics Planning Guidance and the Dorset Informatics Plan for 2009/10. Resources are finite and hence need to be prioritised and this strategy attempts to balance the clinical development needs of the organisation, whilst ensuring that the infrastructure is fit for purpose and future proofed. The IT department is acutely aware of the need to ensure that each project is completed before further projects are undertaken and is seeking investment through the business planning process to enhance delivery through formal project management. This strategy requires a significant investment over the two year period of £2m and appendix 1 (available on request) clearly summarises the individual capital components and consequential revenue costs associated with each scheme. 2.0 INTRODUCTION This document sets out the Trust’s intentions to meet the above requirements, retaining local flexibility in achieving national expectations. The paper expands on the current baseline and focuses on security issues and business continuity. The main developments to be implemented are set out in section 6 with the risks covered in section 8. The developments have been split into 6 areas Clinical - covering areas such as electronic prescribing and capture of additional information to

aid the reporting of clinical outcome data. Business Process - dealing with changes to the current processes to further improve the way

the Trust works, within this section the 18 week wait developments are included. Administration - looking at some of the current administrative processes in the Trust to see

where IT can help to improve efficiencies, such as document scanning and the Management Information System.

Infrastructure - developments such as improved security on the wireless local area network and improved backup solutions.

National Requirements - covering developments the Trust need to make to current systems to continue to keep the Trust in step with national requirements such as Choose & Book.

GP Links - looking at developments to improve the GP access to Trust information and improved links to continue to develop relationships with the GPs.

Any future developments that the department intends to look at are also listed in this strategy.

Vision IT empowers the Trust to deliver high quality health care through innovative and creative business and clinical process.


3.0 BASELINE IT Services Department The IT Services department is made up of 5 teams Systems Management

Supporting the main Unix Servers, running applications such as the Patient Administration System CaMIS and the Finance system.

Clinical database design and support including the creation and development of the infection control system

Internet / Intranet design and development Integration Engine support and development to aid the introduction of new interfaces to link

IT Systems Technical responsibility for the Management Information System Responsible for SUS submissions for the Trust

Network and PC Support PC and Printer Support and Implementation Supporting the Windows servers running applications such as the Trusts’ email Network support and installation of new network points as required Security issues such as Anti Virus control and encryption

IT Projects IT Project Management support for major IT projects in the Trust such as electronic

Prescribing. IT Project Management support for minor implementations such as introducing interfaces to

link two current systems

Application Support and Data Quality Support for the main IT Systems in the Trust including CaMIS / eCaMIS / Tomcat

Cardiology Project support for eCaMIS / CaMIS / Tomcat system developments such as the

implementation of the Order Communications system IT Helpdesk provision Day to day responsibility for the validation and checking of the patient data in the main

CaMIS system

IT Training Provide IT Training to all staff in the Trust both in clinical systems and administrative

systems such as the Microsoft Office suite Offer courses to the hospital staff to assist them in gaining essential IT Skills so that they

can work with the new technology more quickly and efficiently. Currently the European Computer Driving License (ECDL) and Essential IT Skills (EITS) is the way we monitor that.

Timetabled courses are available for regular courses as well the provision of ad hoc courses

Ongoing review of developments in Training to ensure the best provision to the Trust

Within these teams the department offers helpdesk support from 8:30am – 5pm Monday to Friday and Out of Hours Support 24 hours by 7 days a week.


Resources As a result of recent feedback and a Corporate review by Price Waterhouse Coopers the IT Services department is currently reviewing the staff numbers to deliver the current service within the Trust particularly in the area of Project Management. A separate business case will be created with the result of this review. IT Services offer support 24 hours a day and 7 days a week. The out of hours support is for priority one calls only for a subset of the IT Systems. The CaMIS / eCaMIS System is the main Patient Administration system and due to the use of the system the planned upgrades to this system have been contractually moved out of hours and a 24 hours a day and 7 days a week support contract is now in place. The IT Services Department has investigated and intends to implement ITIL (IT Infrastructure Library) during 2009/10. The ITIL provides a framework of best practice guidance for IT Service Management and the department intends to review our current policies and procedures in the areas of Service Delivery and Service Support to improve the current services offered. See Appendix 1 (available on request) – IT Resources / Support for additional information IT Infrastructure Using the IT Capital, investment has been made in PCs for the Trust to meet a minimum specification for all the PCs. Currently in the Trust there are approximately 2000 PCs and over 1000 Printers in use in admin and clinical areas. Regular spot checks are carried out to validate the IT equipment in terms of location and numbers. When old equipment is removed from the Trust this is either destroyed, this is mainly PC hard drives due to the sensitivity of the data on the drive, or some equipment is offered to staff for sale such as PC monitors. Investment has also been made in file servers which allow all members of the Trust to have access to this central storage space which is backed up on a daily basis for additional security of their files and information held on PCs. An ongoing review takes place to ensure there is a capital plan to replace IT equipment to keep the Trust on up to date equipment. The IT Infrastructure will have priority when looking at the IT Capital plan. IT Systems The Patient Administration System in the Trust is CaMIS / eCaMIS ([enterprise] Clinical & Management Information System) supplied by Ascribe. This has been used and developed over the last 10 years. The system is used to manage outpatients, waiting lists, case note tracking, letter creation, contracting plus being the main tool for Information reporting. Departmental systems such as Radiology (Radiology Information System) and Theatres are provided within the CaMIS / eCaMIS System. The CaMIS / eCaMIS patient master index is the central patient database in the Trust. Any new systems will be linked to and pull data from that system so that the consistency of data accuracy around the Trust is retained and no duplicate data entry is ensured. The eCaMIS Clinical Viewer system is the clinical repository for the Trust and any new IT systems will link into this system for full patient record viewing. During 2006/7 an investment was made in eCaMIS to provide Order Communications in the Trust. The Radiology element of this project is now live with CT / MRI requests only being able to be ordered electronically from the 1st April with plans for the ongoing roll out from that date. In May 2009 an update was received for the Cardiology feed but there remain a few issues on the clinical report fully feeding into the Order Communications system, this should be resolved and moved live


during May/June 2009. The Pathology system link for Order Communications has been a complex interface. As at May 2009 a message has now successfully gone between the Order Communications and the Pathology system and therefore this should move forward during May/June 2009. The system the Trust is implementing has the flexibility to cover other requests such as Endoscopy and Therapy services which will be looked at during 2009/10. The introduction of a new Results Viewing module will be added on during June/July 2009 to support electronic sign off of reports. The introduction of Speech Recognition and Digital Dictation within eCaMIS now allows the clinical staff to record all their letters, whether desk work, after a clinic or a discharge for their secretaries to type elsewhere in the organisation. There are also a number of departmental Clinical Systems in the Trust Symphony Emergency Department System. This was implemented in 2008 for use in the

Emergency Department, CDU and AAU. This system supports the live tracking and management of emergency patients.

HICSS (Hospital Information Clinical Support System) is the system in the Trust in use in clinical areas. This is used within Endoscopy, Gastroscopy, Eye Unit A&E, Rheumatology, Hepatology, Cataract Surgery and Gastroenterology.

Diabeta is the system in use in BDEC recording all clinical data about the patients seen as well as producing documentation for GPs after visits.

Telepath Pathology system is located at Poole Hospital and managed by Poole on behalf of both Trusts.

Aspyra Picture Archiving and Communications System (PACS) is installed and fully used within the Trust.

Tomcat Cardiology Information System is now successfully rolled out as the clinical information system for the Cardiac department.

JAC is the Pharmacy System in the Trust and links are in place to ensure the full integration with the eCaMIS system with the TTO drugs feeding to Clinical Viewer.

Lilie GU Medicine system to capture their activity and clinical information. Ongoing review of IT hardware and Clinician training needs to continue to be prioritised across the Trust to assist this staff group in getting the most out of the IT Systems that exist in the Trust and receive their input into future developments to the systems. The main non patient related system in the Trust is the eFinancial Finance System and the Electronic Staff Record (ESR) supplied by McKesson for the Payroll, training and Human Resources functions. Factors for Change There are a number of factors that lead the IT Services Department and the Trust to review their current IT services. Internal Factors Age of equipment – There is an ongoing review of equipment and this is aligned to the IT

Capital Plan to ensure the equipment is kept at a minimum standard. Internal cost improvement programme - Looking at how systems are used and the costs

around those to see where improvements can be made to save money. An example of this is the electronic transfer of letters to GP systems rather than printing and posting copies of letters.

Internal User Groups reviewing current systems – For all the CaMIS / eCaMIS and a number of the other systems there are user groups in place to review the systems and see how minor alterations can be made to get more out of the software to improve the way it works in the Trust.


External Factors Department of Health setting new targets, such as the 18 week from Referral to Treatment. Monitor setting out guidance to FTs to follow for such areas as the National Programme for IT. Caldicott Data Protection Act Freedom of Information National Service Frameworks National Programme for IT (NPfIT) and the NHS Care Record Service (NCRS) NHS Connecting for Health (CfH), which came into operation on 1st April 2005, is an agency of the Department of Health. CfH’s primary purpose is to deliver the National Programme for IT (NPfIT). NPfIT is a multi-billion pound IT project focused on improving patient care by enabling clinicians and other NHS staff to increase their efficiency and effectiveness. Within NPfIT there are a number of sub-projects/deliverables such as Choose and Book, GP to GP and the NHS Care Records System (NCRS). The NCRS is the only area of NPfIT outstanding for this Trust. As required by Monitor, an internal value for money review was conducted for NCRS in January 2007. NCRS covers numerous key IT systems within RBCH including PAS, Theatres, A&E, Ward Prescribing and Order Communications. The conclusion at the time was that the Trust were not minded to take the system. Since the review the Fujitsu’s contract covering the South of England was terminated in May 2008. Negotiations to reset the contract had failed because the two sides were unable to agree on the price and commercial terms. The future arrangements for the South remain under discussion, but the Department’s intention is allow those Trusts which have not yet implemented a new care records system to choose between those offered by the two remaining Local Service Providers, BT and CSC. The Cerner system has been implemented in a number of Trusts in London under BT and a few Trusts in the Southern area, this system continues to have some issues in the organisations that are running it and still do not fully deliver the clinical requirements. Lorenzo is the CSC NCRS Solution and is currently unable to fulfil the full requirements of the NCRS and is not fully implemented in an Acute Trust. At this point in time agreement in Dorset has been given that during 2009/10 a review will be carried out of the existing systems as well as the Local Service Provider solutions if those systems are in a stable enough state for that review. A number of the NPfIT projects have already been met within the Trust. Choose & Book - The Choose & Book link is now fully implemented to the CaMIS Patient

Administration System (PAS). This allows all the PCT / Patient / GP using Choose & Book to select an appointment and book it directly onto the CaMIS PAS.

Data Quality Standards The Trust has a Data Quality team that is focused on the Patient Master Index. The NHS

number is the key field for all patient records and this teams’ primary focus is to resolve the NHS Number for all patient records in the CaMIS PAS.

N3 Network The N3 Network is a dedicated national network across the NHS. This is the method that

the Trust uses to access the Internet, send and receive email and access any external systems through secure firewalls. The Trust was connected to this during 2004.

IT Steering Group The IT Steering Group is the Strategic group for IT in the Trust. The Group is made up of clinicians, pharmacy, a GP representative, general management as well as IT representation and is chaired by the Director of Finance & IT. The group was set up to formulate the Trust’s


Information Management and Technology Strategy taking into account local recommendations as well as the National Programme for IT. All major IT purchases have to be approved by the IT Steering group to ensure central control of any IT related purchases. The IT Steering group approve all the IT related Policies for the Trust as well as direct and approve the spend of the IT Capital budget. Appendix 2 (available on request) – IT Steering Group Terms of Reference – available on request Dorset Informatics Board The Dorset Informatics Board is compiled of Finance Director or Chief Executive or Senior IT for all the health organisations in Dorset. This group suggests the IT direction and IT projects for review for all the organisations in Dorset. All updates and reviews of the National Programme for IT are presented to the group to dictate actions for the IT groups to review. This Board has an advisory capacity only with no budget or management control. The purpose of the group is to share a common IT goal across Dorset for Healthcare. Appendix 3 (available on request) – Dorset Informatics Board Terms of Reference (available on request) Informatics Planning The following documents have been considered when writing this strategy

- The National Informatics Plan (Appendix 4 – available on request) - The South West Informatics Planning Guidance 2009/10 (Appendix 5 – available on

request) - Dorset LHC Informatics Plan 2009/10 (Appendix 6 – available on request)

The main agenda for these documents are the Clinical 5: The Patient Administration system should have the capability to have integration with other systems and support sophisticated reporting - The CaMIS / eCaMIS system currently in the Trust already meets this requirement. Order Communications and Diagnostic Reporting - The eCaMIS Order Communications system will fully support this requirement and the development in June/July 2009 should fulfil the reporting and electronic sign off for this requirement. Letters with Coding - The electronic Immediate Discharge Form along with the GP letter from the Symphony Emergency system should combine with the other letters that are produced in the Trust to ensure that enough coding information is being electronically transmitted to GPs. Scheduling of Beds, Tests and Theatres - A review needs to take place in 2009/10 to find out the gaps in the current eCaMIS system to fulfil the requirements on this issue but the current system is a large percentage of the way to meeting this need. ePrescribing - This is a project planned for 2009/10. 4.0 REVIEW OF 2007 – 2009 PROJECTS Accident & Emergency Management and Clinical System With the introduction of the Symphony Emergency system the requirement for the data capture developments within eCaMIS for CDU / AAU has been removed. The Symphony system was


implemented in December 2008 to resolve all Emergency Care tracking in the Emergency Department, Clinical Decision Unit and Acute Admissions Unit. The system has improved the live monitoring and tracking of patients within the Emergency Department and related areas. This includes an electronic white board to show when patients need to be moved up the priority list and embedded guidelines to aid treatment Data quality with the Emergency Department is improved with increased data collection on clinical information. This improved data quality provides the Trust with comprehensive payment by results information.

The system will support Emergency Department moves towards being paper lite. The system allows the reduced paper record to be scanned within the department. This would result in virtually no notes storage space being needed.

The integration with AAU and CDU allows the automatic production of electronic GP discharge letters eIDF (Electronic Immediate Discharge Form) During 2008/9 the introduction of the electronic immediate discharge form has been stilted due to the complexity of the patients. An alternative, free text, version of the form is being launched in May 2009 to try to cover this issue. From the 1st April all patients discharged should have an agreed electronic discharge document. The current form is a manual form where minimal data is pulled into the form with the clinicians completing all the data in the form to support the discharge process, coding function and correspondence with GPs. A review has taken place of the eIDF and during June 2009 a new version of the form will be implemented with the Co-Morbidities information automatically pulled into the form. In July / August 2009 another version of the form will be implemented to automatically pull in Theatres and Waiting List Management data. From this point a detailed review will be carried out to look at the automatic population of the form feeding from the Order Communications, Radiology and other related system. This should ensure that the eIDF is electronically populated and only GP instructions and additional instructions for discharge need to be added. Additional PCs have been installed across the Trust to support the collection of the eIDF data and this will continue to be reviewed. 18 Week Wait The CaMIS / eCaMIS system was updated in August 2008 to support the capture and tracking of the 18 week referral to treatment pathway for patients. The changes for users have been considerable and a number of review meetings have taken place to ensure users are using the system correctly. The data from the system is now starting to be used in reporting of the 18 week position. This affords us the opportunity to identify issues and delays on patient’s pathways thereby being able to implement required changes to minimise any breaches due to Hospital processes and procedures. A few additional developments are required and are scheduled in 2009/10 to try to ensure the older activity, pre August go live, is put onto a pathway as they are actioned.


To further support the use of the pathways within CaMIS / eCaMIS the system has been configured to cope with emergency pathways where it does not create a Referral to treatment Pathway. The reason for this change is to ease the tracking of the use of the system by staff. Care Pathways With the introduction of the CaMIS / eCaMIS system the patient pathway is now clearer for tracking and monitoring. The funding for this development was spent on the Tracking module within eCaMIS which will allow the electronic tracking and movement of patients around the Trust. This will support some element of care pathway tracking and the further use of Order Communications will also assist with this. Management Information System The Management Information System is the Intranet based reporting system that pulls data from the main IT systems for reporting activity and performance data. A Steering Group was re-formed in March 2009 to ensure that this system delivers the required reports in a usable format for the senior managers in the Trust. This system also supports the emailing out of reports to staff to action which should also speed up some elements of validation in the Trust. The MIS should be the portal used and developed to share data with the Clinicians in the Trust so they can review the current position with their patient lists. The Information Department have a number of projects underway to push the roll out of this system across the Trust. The MIS supports the validation of Data Quality for NHS Number tracing but also for the Secondary User Service (SUS) extracts. This validation is carried out on a daily basis to ensure the current data quality for inpatients and outpatients is maintained. The SUS extracts are used by the PCT for contractual purposes. Developments in June 2009 will support the increased availability of Theatres data to enable more enhanced Theatre utilisation reporting. Radiology reports are also being added in May 2009 to make the availability of this data more wide spread and more easily viewed and shared. There has been an End of Life declared for the Support and Development of the current product that we use as the front end of the reporting system for the MIS. This may mean that during the next 3 years an alternative front end reporting tool is investigated. The supplier has been taken over by Microsoft so a product may be in the pipeline from them but this is currently unclear. Scanning of Medical Casenotes Phase I of the eCaMIS Scanning system has now been implemented and taken live. We have commenced scanning Maternity notes and loading these into the system. A roll out plan is currently being devised in Health Records to move those notes which meet the scanning criteria onto this electronic storage solution.

Phase II of this system will provide the ability to electronically export documents, upload documents into certain sections of the note, improved viewing of the documents, all of these with full audit trail. This is due in 2009/10. Digital Dictation / Speech Recognition Digital dictation and speech recognition capability has recently been developed within eCaMIS and is intended to be used as an alternative to the traditional audio dictation cassette. Speech recognition transcribes the spoken word with digital dictation only recording it.


All types of correspondence can be digitally recorded directly into eCaMIS, including; ward round notes, operation letters, discharge summaries, clinic letters and desk work. There has been a continual roll out of digital dictation over the last few years with successful results and enthusiastic feedback. The majority of specialities in the Trust are using digital dictation to some extent. The key benefits being:- Once a dictation has been recorded it can be transcribed within minutes onto eCaMIS and be

made available for electronic transfer to GPs. Risk of tapes being lost or damaged is eliminated. Quality is far better than audio tapes Background noise is reduced by digital filtering. Analogue Dictaphones and tapes don’t need to be replaced, cutting costs. Urgent letters are easily identified so they can be prioritised for processing.

The roll out of speech recognition has not been as successful because it is a two step process and most secretaries preferring to type letters rather than correct them. Real time speech recognition would be advantageous for areas with no secretarial support where clinicians can correct their own dictations in an easy, one-step process. Investigations are ongoing in 2009/10 to utilise digital dictation for all correspondence i.e. patient related and non-patient related. This will incorporate using digital dictation in other patient management systems such as Tomcat/Diabeta and dictating outside of the Trust to get the most out of the current investment. Telemedicine for Stroke The Telemedicine System has been installed in Accident and Emergency for the out of hour’s treatment of Stroke patients. The system consists of a digital network including a 2-way video conference between the patient and physician and CT/MRI-image transfer using a high-speed-data transmission. The video camera captures real-time clinical signs from the patient, and the computer screen enables the patient to view and communicate with the remote "stroke expert”. Using the highest image and sound quality for simultaneous image transfer and medical communication between physician and patient - each member of our on call Stroke Team have a small and high-grade workstation that they use via the 3G network to receive and send DICOM data and integrated PACS images. This enables the consultant to virtually assess the patient and take appropriate action. This project won the Health & Social Care Award for Innovation from the Department of Health in the South West Region in May 2009. N3 COIN During 2008 a joint project between RBCH, Poole Hospital and BT N3SP was undertaken to provide resiliency in both Trusts’ N3 connections. Up until this project both Trust's had to rely on a single N3 connection each. Both of these connections terminated in the Poole BT exchange. The N3 COIN (Community of Interest Network) solution was to provide RBCH with a new higher bandwidth circuit to Southampton exchange using Virgin Media as a carrier. Poole Hospital kept their existing circuit to Poole exchange but with increased bandwidth. A third, triangulating, circuit was then installed between RBCH and Poole hospital using a different carrier again. This provides both Trusts with a resilient connection to N3 if a circuit should fail. The project was completed on time and without any significant disruption to users


5.0 SECURITY AND BUSINESS CONTINUITY Security and Virus Control There are a number of security solutions in the Trust to protect the organisation from any malicious threats. All the central servers are backed up and maintained by the IT Services department and the servers are located in the secure data center with back up tapes in a fire proof safe in the Education Centre. PCs are not routinely setup to centrally backup, however this option is available to staff. The IT Security Policy, available on the Intranet, lays out the security recommendations for staff in the Trust. Anti-Virus software is installed on all equipment in the Trust and is centrally maintained to ensure this is kept up to date. The anti-virus software checks every few hours for updates via the web and those updates are made onto the PCs in the Trust every four to six hours. There is always a small risk that a new virus may not be recognised and when an anti virus solution has not been identified and before the anti-virus software is updated, however this could only get into the Trust via the email system. Email security has now been updated to protect the Trust against Spam/junk mail and there is also full anti-virus software on the email server. Access to the internet is subject to two levels of security device to protect the Trust. All active content on web pages is checked and there is URL filtering in place which restricts sites that staff can access. We will shortly be implementing an email encryption solution which will enable seamless encryption between all Health organisations in Dorset and any other Health organisation that uses the same TLS technology in their email encryption appliances, without the need for any user intervention. The encryption appliances will also provide comprehensive anti-spam filtering and anti-virus scanning. It will also enable policy based encryption of email outside of the health arena. Outside of the health arena, on receipt of an encrypted email the receiver will be required to register once with the Cisco CRES service to unencrypt the email. On subsequent receipts of encrypted email the receiver will only have to logon to the Cisco CRES service to unencrypt the email. Network security ensures that only valid equipment is connected to the computer network so that security is maintained. There are firewalls between the Trust and any external connection which ensures that no unauthorised access in or out can take place. The Wireless Local Area Network does have a level of security built into it so we are secure but this is being updated and expanded in 2009/10. Remote access security is tightly controlled with two alternative solutions available to staff, depending on connections at their home address. Both systems are secure with challenge response authentication devices ensuring secure access and they also have intrusion detection and prevention which is checked daily. During 2006/2007 Windows Active directory was installed in the Trust and this provides central authentication and authorisation for any Windows based computer. Active directory also allows administrators to assign policies, deploy software and apply updates to the whole Trust from a central system.


Security is monitored on an ongoing basis to see what needs to be investigated in the Trust to improve the security that currently exists. Removable Media encryption As part of Information Security and Information Governance the Data Security in the Trust must be looked at to ensure any data movement is totally secure. Port control is a feature within the centrally purchased Device Control product and it allows central control of the use of removal media for the storage of data. The intention is to implement the following controls, as confirmed by the IT Steering Group:

1. CD drives to be configured as read only across the Trust. The only exception for this is the creation of PACS and Cardiac Image CDs where a separate encryption process must be used.

2. USB devices to be configured so that all devices be read across the Trust. The PC and network anti virus software will check for any security issues prior to accepting this data onto the PCs.

3. Recommended encrypted USB Devices can be used to write data to. These USB devices must be encrypted for the level of security required with this data. The list of recommended devices will be agreed between IT Services and Commercial Services so staff can go to Commercial Services to purchase these.

4. Palm Pilot / PDA/iPhones – these are still to be clarified. Preparation has commenced in the Trust with the purchase of encrypted USB devices. Data Centre Following an IT Disaster Recovery Risk Analysis exercise in June 2006, significant risks were identified with housing most of the Trust’s IT equipment in the main Hospital telephone switch room. As a result of this, funding was provided to facilitate the construction of a dedicated Computer Room on the Trust campus. This project was completed with ongoing revenue costs included within the IT Budget. Since the completion of the data centre all the servers were relocated to the secure purpose built computing facility located on the roof. Physical security includes fire protection, suppressant and resistant materials used in manufacture of the room. The floor is raised which protects the room from flood. The physical location of the room is a theft deterrent, coupled with alarmed entry and a keyed lock that cannot be copied. The room is also protected by CCTV internally. A UPS (Uninterruptible Power Supply) supplies power to all servers in the room and generator power ensures the room is on essential power. Windows Servers All windows servers are backed up either to disk or tape on a nightly basis, Monday to Friday. A comprehensive backup tape rotation is followed to ensure a wide spread of backups available in the case of an emergency. All windows servers have built in resilience comprising teamed network connections, redundant power supplies and fans as well as disk arrays allowing for a disk failure without data loss or system failure. All windows servers are covered by a 4 hour extended hours maintenance contract for repair or replacement of faulty components.


The restoration of a server depending on the severity of the incident, can be completed within 1 working day for a serious failure, subject to hardware being available or repaired, to 1 hour for a simple file restore if a user has corrupted or inadvertently deleted a file. With the current backup plan the maximum data loss would be 1 working day. This is felt to be an acceptable level of risk. Unix Servers The main risks with the Unix servers are manual error, hardware failure (most components are dual redundant ie no single fault can cause a failure), Fire/Flood/Act of God and Theft. The Implications of any of these would damage the availability of clinical systems (CaMIS / eCaMIS, Choose & Book, Radiology), support systems (Finance) and any dependant systems (Systems can be reliant on CaMIS for interface connections) depending on the Unix server affected. There is a potential permanent loss of vital patient information core to the Trusts business and affecting its operational capability. The restoration of a server varies greatly depending on the nature of the restore. Disaster Recovery invocation where a server is supplied on site can be up to 12 hours to restore. Simple hardware faults would be a maximum of 6 hours. Simple software faults or site correctible hardware faults would be a maximum of 4 hours. Data is backed up to tape daily and stored in a safe in the education centre. Weekly and monthly cycling of tapes is performed, making it possible to retrieve data up to 2 months old if necessary. Tapes are replaced as required. Transaction logs are copied at more regular intervals (every hour) for those servers that support transaction logging (CaMIS, Choose & Book). Disaster Recovery testing is performed twice per year, either at an off-site facility or on-site. Test recoveries are performed and procedures/timings are updated accordingly. Restore procedures for Radiology, CaMIS and Finance are held on site. With the current backup plan the maximum data loss would be 1 working day. This is felt to be an acceptable level of risk. Disaster Recovery Based on experiences learned from 9/11 and the London Bombings, physical access to the appropriate buildings is necessary to recover services. In reality, denial of access can be a major issue/delay whilst the relevant emergency services resolve the situation. To address this risk which has been added to the IT Risk Register a Trust Wide Business Continuity/Co-Location plan will be constructed. This would allow for a backup location holding our data so the Trust could run from that site if anything should happen to the primary site. The construction of the Business Continuity / Co-Location Plan will be completed during 2009/10 and reviewed by the IT Steering Group to assess whether this should go forward as a proposal for a Capital Development in 2010/11. 6.0 IT DEVELOPMENTS Clinical Electronic Prescribing / Medicines Management This project was originally put in for 2007-09 but with the planned implementation of the Pharmacy robot it was agreed that this project would be delayed until 2009/10. A fact finding demonstration and review meeting in January 2009 has confirmed clinical engagement to move this forward.


Electronic prescribing systems support the whole medicines use process. They will enable medicines to be managed electronically at every stage, from prescribing through to supply and administration. Electronic prescribing should facilitate wider improvements in prescribing and administration processes, including reductions in paperwork / improved audit trails for medication and improved communications. The software also incorporates decision support, aiding the choice of medicines and other therapies with alerts such as drug interactions. Electronic prescribing and dispensing is a development that intends to be investigated due to the clinical benefits around this particularly in prescription errors / decision support. A review will be carried out with IT and Pharmacy during 2009/10 to look at the 2 system options (1) an expansion of the JAC pharmacy system or (2) purchase the functionality within the Ascribe system being used for Order Communications. This is a major development with estimated costs of £300k. Chemotherapy Prescribing The HOPS (Haematology Oncology Prescribing System) is currently in use in the Trust to support chemotherapy prescribing. Across the Dorset Cancer Network it has been agreed that a replacement system for this needs to be considered. At RBCH an option would be to include the Chemotherapy prescribing within the Electronic Prescribing project rather than purchase a separate IT solution. This will need to be reviewed within the electronic prescribing project. Cancer Information System Within the Trust it has been supported for a number of years that a single Cancer Information System is required. Currently up to 10 separate systems are used to collect the specific cancer sites and waiting list information. A Dorset Cancer Network project was running to look at the implementation of a single system across Dorset, however this has now been abandoned and Trusts are being advised to select their own system to provide for this. RBCH are looking at a number of system choices for the collection, reporting and tracking of Cancer Patients and hope to look at implementing a system during 2009/10. This is a medium development of approximately £50k. Inpatient Tool for Clinicians The Inpatient Tool moved forward during March 2009 when the discussion of a future development commenced. The review of the requirements for this has changed from the original plans. This is due to the planned changes to the eIDF. The requirement is now to create an electronic work list for Inpatients. This has been specified and is moving forward. This is a medium development with estimated costs of £20k. ( c/fwd funding 08/09) Pathology System Replacement There are two elements to the Pathology System replacement that must be considered. These are Histopathology, which is a very text base requirement and report, and the blood sciences where they are more statistical results with feeds from analysers. Clinical agreement was gained at the IT Steering Group that the Histopathology IT requirements are key to providing complete data based reports including Cancer profile completion. A NPfIT project had commenced looking at a Pathology system and this is being investigated as an option. However, at this point in time it is felt that there should remain one Pathology system due to the purchase price and ongoing revenue consequences. Therefore the intention is that the Pathology system replacement takes place in 2010/11 in conjunction with Poole Hospital. At that point the


Histopathology requirements must have a high priority in the specification of the new system to ensure their clinical requirements are met. The pathology system replacement is a large development with an estimated cost of £250k. Orthodontic System Replacement The current Orthodontic system needs to be reviewed and potentially replaced. The current system does not currently support a full clinical system for the department. The paper notes are currently required to be able to manage the patient. Therefore a system replacement will be looked at to move forward with a paper lite solution. This is a medium development with an estimated cost of £50,000. Clinical Outcome Data The Introduction of the Commissioning for Quality and Innovation (CQUIN) may identify the need for additional clinical outcome data to be collected within current IT systems. This requirement is currently unknown but a budget will be allocated towards this to assist in the collection of data to support CQUIN. This is a medium development of an estimated £20,000. Clinical Viewer Links There are a few remaining systems that are not feeding clinical reports and data into the eCaMIS Clinical Viewer system and this is a requirement to create a central clinical record. An example of this is a link to the DAWN Warfarin system and the Thoracic Spirometry system. This is a medium development of an estimated £20,000. Maternity System To date the Maternity department at the Trust have used elements of the CaMIS Patient Administration System to collect information about their activity in Outpatients and Inpatients. Also they use a web link to the NHS Number for Babies site to register babies to get NHS numbers for them at birth. These systems have not fully supported the requirements of the department and have not supported the ongoing planning of the staff in terms of expected deliveries. Therefore a Maternity System needs to be implemented in the Trust to support this clinical function. This is a medium development of approximately £50k. Business Process Radiology Information System (RIS) The introduction of Order Communications and the attempt to introduce Digital Dictation within Radiology has highlighted the shortcomings of the current RIS. The Radiology department is currently reliant on a request form to move a patient around the department as this document triggers the next step in their pathway. As part of the Order Communications system the idea of removing the request form was abandoned as the RIS could not support a paperless process. Digital Dictation was to be introduced within Radiology but the clinical staff were concerned about the lack of links between the RIS and the PACS which raised concerns over errors or dictating reports on the wrong patient. A re-design specification has been created with the assumption that this is the route the Trust will take, however this is under review with the current concerns about the lifetime of the current PACS. This is a large development with estimated costs of £60k. (c/fwd funding from 08/09)


Administrative Website Re-Design IT will be focussing on restructuring the web content in-line with the specification of marketing and communications and changing the look and feel where it is deemed appropriate. Visual and audio media will be used to a greater degree – though the implications and associated resource costs of creating such productions must also be considered. Social networking platforms are an area that we need to investigate for the website. It is considered that more work needs to be done on the management of perception; as presented via NHS Choices and any disassociated forum. Social networking tools can themselves be used for this purpose, but before adding to the burden; we should devise methods of managing the various areas where negative opinion may currently be presented. Discussion with NHS Choices has led us to believe that we can integrate our site tightly with the NHS Choices site. A key element that we would gain out of this is providing an online feedback form to patients on our site that posts feedback directly to the NHS Choices site, via their moderation processes. We could also pull this feedback back to our own site via their RSS feed. This would result in a central online store of patient feedback that users can access and add to from multiple locations. Web Site Accessibility The redevelopment of our external website should be considered a priority in order for us to meet legal requirements defined in the Disability Discrimination Act (DDA 1995) and the Disability Discrimination Act Code of Practice (DDA-CoP 2002) for web accessibility. Redeveloping our website to meet the Web Content Accessibility Guidelines (WCAG) 2.0 compliance level AAA will exceed the legal requirements and result in a website that will be fully accessible to the vast majority of groups. It will also place our website higher in search engine rankings, resulting in more visitors to the site. Content Management Implementation of a Content Management System (CMS) on the external website to allow for a document control process, including approval and versioning mechanisms. A CMS would permit content to expire, automatically removing it from the website where practical, and would create the option to distribute content management throughout the Trust. The CMS will integrate with our document management system which manages approval mechanisms (workflow), version management, storage and delivery of core protocols and procedures etc. After these essential changes are implemented we would be able to look at implementing a richer, more dynamic user environment, resulting in the provision of both a web site and web services. This is a large development with a cost of approximately £100k. Use of mobile devices and email messaging Once the core patient record on the Patient Administration System has the capability to store the mobile number and email address of the patient, we intend on implementing basic services – appointment reminders, pathology result notification etc. Email and electronic interchange forms part of the paperless component of the IT Strategy. Due to confidentiality and governance


requirements there are limitations on the types of information and transmission mechanisms that can be used to communicate directly with patients – where possible we intend on implementing electronic communication if preferred. Self Service Information Kiosks Self Check-in screens have been implemented in the main clinic areas in the Trust to support patients self arriving to clinic. With the use of this system we can continue to carry out the demographic checks required and electronically arrive patients in clinic. The extension to this or introduction of additional kiosks is being investigated to look at the ability for on line questionnaires, update on waiting times and way finding around the Trust. eCaMIS Theatre System The current eCaMIS Theatre System has been in the organisation for a number of years now and should be reviewed alongside the care pathway work being done to support the 18 week wait work. The Trust will need to ensure that the system fully supports direct booking, equipment ordering and improved scheduling. eTCI (eCaMIS To Come In) A development is being investigated to look at the Admissions process in the Trust. This includes the replacement of the current TCI cards in the Trust with an electronic form. As part of this development there is also an intention to put the screening forms on eCaMIS and review the screening process of patients to ensure they are fit to go onto Inpatient and Day Case Waiting Lists for scheduling. Customer Relationship Management (CRM) The current system that is used to support the Foundation Trust members has been developed in house but it has been agreed that this no longer meets the requirements of the Trust and the mandatory submissions required by Monitor. During 2009/10 a new Foundation Trust Membership will be investigated and selected to resolve the data collection and management reporting required for Trust members. Single Assessment Process The Single Assessment Process is used to ensure that patients receive appropriate, effective and timely responses to their health and social care needs. Through the use of shared assessment documents the agencies involved in the patient’s care share their information. Currently the single assessment process is a manual process across Dorset. The PAN Dorset SAP Steering Group has been reviewing the option of an IT System to support this process across Dorset. The solution will allow the entry of the Assessment into the IT system for all staff in the process to be able to monitor and review, as well as having access to the record from the Accident and Emergency department. This is a medium development with estimated costs of £20k. (c/fwd funding 08/09) eLearning New Information Governance guidelines and a greater reliance on the use of Patient Management Systems highlighted the need for more flexible options to train new staff and update existing staff on the systems currently in use. The use and development of eLearning was investigated as an option to address issues such as difficulties with releasing staff from their work environment, more timely training of staff and some Mandatory Training issues at the Trust.


Two solutions were required; a Learning Management System (LMS) to access eLearning and record its completion; and eLearning Authoring software to create our own local in-house e-learning content. Learning Management System; we decided to utilise the National Learning Management System (NLMS), a joint initiative between the Department of Health, NHS Connecting for Health and ESR project because:- It was provided free of charge to NHS Organisations saving the cost of purchase,

implementation, maintenance & support of 3rd party solution Enables the delivery of national & local e-learning content to employees - e-learning being

available to all employees with a staff record on ESR. Centralises the Trusts Training services, with all departments using one system to record

training activity. This provides a complete picture of an employees individual training record. Integrated with payroll and HR systems to provide a single, complete employee record created

and maintained with training history, competency profile, qualifications, schools & colleges and appraisal details.

Option to automatically update ESR employee records with training undertaken, competencies and qualifications achieved.

National competency frameworks are built in (KSF, NOS, NWC) plus ability to define local competencies and rating scales e.g. mandatory refresher training can be identified and reported on when the competence is ready for renewal.

Creates a portable training record for employees who transfer to other NHS Trusts. Self Service functionality allows employees to view all course offerings and play e-learning

courses. Some courses also allow self enrolment! Skills matching, skill gaps and requirements can be highlighted with the ability to create

learning paths. Training can be targeted to match career frameworks reducing costs and improving employee feedback.

Enables remote access to e-learning content, but ensures security of ESR core application.

Authoring Software; we purchased KS Tutor supplied by Knowledge Solutions to create our own eLearning content because this software enabled both eLearning content and system simulation content to be created. It met the requirements laid down by the Learning and Development committee e.g. inbuilt checks to ensure that the learner has completed all areas of the course and SCORM compliant to ensure compatibility with the NLMS etc. It also enables us to provide ‘point of access’ eLearning i.e. context specific help whilst in the live application. We are currently using the NLMS for NHS ELITE & NHS Health (nationally provided eLearning). The next step is to add our own authored eLearning content for RBCH specific Patient Management Systems and for the national Information Governance eLearning when it becomes available. Our aim for the future is to expand our eLearning catalogue providing employees’ with greater flexibility and a choice as to how they learn e.g. instructor led sessions or eLearning. Document Storage / Scanning Solution for Non Patient Documents Starting in April 2009 the Trust is implementing the ImageNow Document Management solution, initially as a pilot within 4 business area’s: Accounts Payable, Human Resources, Risk Management and Commercial Services with the key driver being to provide a scalable solution with the ability to move as much of their paper and processes to a paperless system as possible. This was further extended to include a Reference Database trial for clinical material collected by the Oncology Department and to provide various departments a platform for their meetings to go paperless.


At a high level ImageNow creates a direct and effortless connection between workers and the documents they need to complete their daily activities. ImageNow allows customers to efficiently capture and organize all types of documents, then retrieve a precise page instantly from within any business application at the moment it's needed. From a Trust perspective Accounts Payable use the system to scan and electronically sign-off invoices, coupled with the scanning of goods-in receipts which is linked to our Powergate requisitioning system. Risk Management use it to capture a variety of forms, including: Adverse Incident Report, Risk Assessments, IOSH forms (Risk Management course), Closed Claims & Training Records. Commercials Services in tandem with Accounts Payable, also take advantage of the link to Powergate and use the system for the storage and collection of documents relating to tenders and general procurement. Human Resources have used the system to store leavers personnel records in conjunction with trialing the ability of moving all members of staff personnel files to the document store. This department has also taken advantage of the workflow capabilities, using it to route and file paperwork between the different HR locations and to move the “new hire of staff” process to as paperless a system as possible. The benefits of doing this project include: Free up physical storage space (e.g. 4000+ personal records/files for HR); Eliminate lost documents in the organisation and reduce “time to find”; Current paper based workflows (e.g. approval of invoices) will have the ability to go electronic; Aids the implementation of robust document retention policies; improving compliance; Multiple access to the same document with version control; Audit control (who looks at any document, checks out etc); Provides a platform for meetings to go paperless.

The general objectives for this deployment address the following business needs: Provide an enterprise document management, imaging and workflow solution integrated with

the Trust’s business applications A reduction in the amount of paper file storage at the Trust Improve and speed up the retrieval of information once scanned Reduce the amount of printing at the Trust, taking advantage of the associated cost savings Provide a central, secure and robust platform for the storage A move towards paperless meetings Assist with the compliance with regulatory and legislative requirements for the storage and

retention of paper documents Use as a project management tool, providing version control and central document storage

facilities (to improve project management efficiency) Overall reduction in “paper” Provide a solution fully supported for all Trust locations Provide a solution scalable and flexible, supporting a growing environment Provide a solution rich in functionality with the ability to add additional software modules.

Office 2007 IT will target to complete the implementation of Office 2007 during the 2009-2011 period. This implementation will be a major change for the Trust as the systems are quite different so extensive training courses will need to be available before any upgrade can be carried out. eCaMIS / Tomcat link for Cardiology Activity Data The Tomcat Cardiology system is currently fed Patient Demographic Information and, through Order Communications, it will feed the Results/Reports back to eCaMIS Clinical Viewer. An additional link is required to feed the activity data from the Tomcat Cardiology system to the CaMIS / eCaMIS Patient Administration System.


The activity that will be sent into the PAS can then be extracted as required for charging to the PCT. This development is dependent on the Tomcat system supplier supporting the changes required by the Trust to facilitate this. This development in an unknown cost at this point but would be justified based on additional income. eCaMIS / Diabetic link for Co-Morbidity Data The Diabetic system Diabeta is currently used to record clinical information about patients in that treatment area. There is a demographic link to this system from the eCaMIS Patient Administration System and the letters on the Diabetic system are also available on the eCaMIS Clinical Viewer. To further expand this sharing of data a link is currently being investigated to share co-morbidity data between the Diabetic system and the eCaMIS system. This is to ensure that duplicate entry is not required in the Trust. The Infrastructure Radio Frequency Identification (RFID) This technology allows the tracking of people / items across the Trust using a radio frequency device and transmitters. In June 2007 the first project of this type went live in RBCH with the tracking of wandering patients. This allows patients / babies that are at risk to wear a RFID bracelet and there are transmitters around the Trust that will flag alarms and messages when the patient moves into certain areas. Further developments to this technology could allow the tracking of expensive assets in the Trust as well as potentially patient notes. The intention is to the use the wireless network in the Trust which should support coverage across the whole Trust by the end of 2009/10. Wireless Local Area Network Further areas to be improved on the Wireless Local Area Network are: The wireless network does not have a wireless firewall or intrusion prevention system There has been no test of broadcast signal strength for security purposes There has been no attempt to detect unapproved wireless networks. The implementation of the upgrade of the wireless network to give full site coverage for data, image and voice with plans to complete this in 2009/10. This is a large development in 9/10 with estimated costs of £300k. Voice over IP (VoIP) VoIP is a new technology that allows telephones and data networks to travel along the same lines in the Trust. This improves flexibility of moves around the organisation as the telephone would have an IP address which would be movable without any external settings. There are some equipment costs such as servers and additional networking to implement this which would support the Call Manager system which routes and controls the calls. The higher cost would be around the change of the telephones to IP based phones as this would be an initial expense. A pilot of VOIP is intended in 2010/11 to put an IP telephone on each ward area. This will allow the testing of this technology but also provide an alternative phone route should there be a need in an emergency situation. This is a medium development of approximately £50k.


National Requirements Summary Care Record System The overall goal of the NHS Care Record Service Programme is to deliver an integrated care record for the NHS in England. This consists of 2 parts, patient’s demographics and Clinical Information. The Demographics Programme is tasked to provide a national, authoritative source of demographics for the whole of the NHS, underpinning all national and local NHS Care Record Service Applications. This is known as the Personal Demographic Service (PDS). The PDS service can be used accurately and efficiently to trace patients against a patient’s most up to date demographic details, thus identifying the patient’s NHS Number. The Clinical Record is due to be implemented in two phases. The first phase is an early adopter phase based on the General Practice contribution to the NHS Summary Record and access to this summary information from an unscheduled care setting, such as Accident and Emergency. Dorset PCT have are an Early Adopter for this project working to send GP allergy and drug information to the Summary Care Record. In March 2009 RBCH FT were accepted as a fast follower pilot to work with NHS Bournemouth and Poole on the Summary Care Record project with links to the Ascribe Symphony Emergency Department system. The links and work required for the Symphony changes are currently unknown but has been estimated at a medium development with estimated costs of £20k. (c/fwd funding 08/09) GP Developments GPs are important to the organisation and as a result investment has been made to improve the data available to the GPs in our locality. Web Clinical Viewer Over 1800 users are registered on the Web Clinical Viewer system, these are users from external organisations, primarily GP practices. This system has access to the same data as the Trust based eCaMIS Clinical Viewer but in an internet browser. This system allows the GP to see all the clinical and administrative information the Trust has about the patient. There are restrictions so the GPs can only see patients in their practice. The implementation of automated password change on the Web CV has increased the security of this application and made it easier for GPs to remember passwords on the system. Investigations are currently underway to link in Document Scanning to the Web Clinical Viewer so that GPs could see the actual scanned documents on the patient record. Picture Archiving System (PACS) Viewer A development was purchased to our PACS system for 20 licences for GPs to access a web viewer of the PACS system. This allows the GP to see the actual PACS image as well as the report for the patient. Electronic Transfer of Letters The electronic transfer of letters from the Trust to GPs has been an ongoing project during 2008/9. With developments in the PCT the plan is for all GPs to be able to receive electronic documents during 2009/10.


To this end test messages are being sent to GPs during May 2009 to ensure we can meet this deadline. The intention is that all letters created in eCaMIS such as Clinic letters, immediate discharge form, discharge letters, operation letters will all be available to be electronically submitted. Also developments are underway to support electronic letters from the HICSS system for Endoscopy, Gastroenterology, Eye Unit A&E etc. The Symphony implementation also provides an electronic GP letter module to support their letters being electronically submitted to GPs. This should ensure that the Trust can electronically send all documents to GPs in Dorset during 2009/10. Work has commenced with Hampshire to look at a solution for that area also. Order Communications Currently the GPs complete request forms to refer patients into the Trust. These forms are completed by hand resulting in data quality issues and further errors result from re-typing into the system. The PCTs in East Dorset are investigating potential solutions to this and there are a number of systems available which would link from the GP system to the ordering system. The indications are that the Trusts would benefit as much from this as the GPs therefore there would be a contribution to this project required from the Trust. This would feed the requests directly into the Trust in the same way the Trust Order Communications does. 7.0 FUTURE DEVELOPMENT POSSIBILITIES Main CaMIS / eCaMIS Server In January 2006 funding was approved for the replacement/upgrade of the Trust’s main computer system, the CaMIS Server. This project was completed with ongoing revenue costs included within the IT Budget. As part of this upgrade, additional ‘spare’ processor capacity was delivered by Hewlett Packard (HP). When this additional capacity is required, the Trust will be required to pay pre-agreed extra monies to activate the hardware. The funding of this must be included within the future eCaMIS / CaMIS related projects where a risk is identified that additional processing power may be required. In the next 2 years RBCH will need to review the existing CaMIS Server on the following grounds:

Performance/scalability Operating system (as dictated by HP, Trust will need to migrate away from Tru64) NPfIT / NCRS Hardware support

This will be done in conjunction with the CaMIS supplier as the application will need to be ported to a new operating system platform with estimated future costs of £250k. PACS Review A review of the current PACS system needs to be carried out due to the end of life announcement of the current PACS. Part of this review should look at the clinical requirements as well as radiology requirements of the system and the links between RBCH FT and Poole Hospital to ensure that any clinically relevant images are shared between the organisations.


8.0 RISKS Detailed below are the risks highlighted as part of the strategy Ascribe The CaMIS / eCaMIS system was developed by Hospital Engineering Information Systems (HEIS) and over the last 12 years the Trust has increased the amount of applications in use from this supplier. During 2006/7 HEIS was acquired by Ascribe which is a software company that started business focusing on Pharmacy System Solutions but who have developed its portfolio to cover all aspects of NHS system solutions. Due to the amount of software already with this company and the planned increase with the projects listed in this document the financial viability and risk of this company has been investigated. Ascribe financials Ascribe was incorporated in October 2001 as a private limited company. Ascribe acquired HEIS in 2006. HEIS has provided the Trust with product development and maintenance support to CaMIS for approximately 10 years prior to the acquisition date. A financial analysis report provided by Dun & Bradstreet shows the company as generating turnover of £6.2m in 2004 rising each subsequent year to £17.4m in 2008. Profits before tax rose from £0.1m in 2004 to £3.8m in 2008. In terms of company failure, it scores 47 out of 100, which means that 53% of UK businesses have a lower risk of failure in the Dun & Bradstreet database. The company’s strategy has placed itself in the market to sell directly to hospitals to provide solutions, which are compliant with the NPfIT initiation. The company’s liquidity has improved from a worrying position as at 30th June 2007 when it it recorded net current liabilities of £3.0m to £1.2m as at 30th June 2008. The company claims it has a strong order book but must be in a position to deal with its cash flow issues. The risk is not seen as sufficiently high to cause a problem but will continue to be monitored. See Appendix 7 (available on request) for additional financial information if required. Appendix 8 (available on request) is a response from Ascribe Finance Director on the risk review. NHS Care Record System The current position with the National provision of an NHS Care Record System is unknown for the South West at this point. Attendance at the Chief Information Officer Forum and the Dorset Informatics Board is where an update should be received to be able to understand how the changes affect the Trust. IT Department Skills and Knowledge With an ever changing IT environment one of the challenges faced by the IT Services department is to keep up with the current technology and the skills to support that. Through the use of the Training allocation to IT Services the skills within the department will continue to be monitored and developed to meet the changing demands for support and implementation of IT systems.


9.0 SUMMARY This Strategy sets out the current baseline of the IT systems and Infrastructure in place. It also sets out a challenging list of developments and projects for the IT Services department to progress during 2009 – 2011. These projects take into account external and internal factors and can be summarised in the following list of actions split between 2009/10 and 2010/11.

2009/10

Clinical

Electronic Prescribing IPS Junior Doctor Tool Clinical Outcome Information Clinical Viewer Links Cancer Information System

Business Process

RIS Redesign Document storage link to the

Intranet / Internet site. Administrative Single Assessment Process

Infrastructure Wireless Network Expansion Replacement of old IT hardware

National Requirements

Summary Care Record

GP Developments

GP Order Communications

2010/11

Clinical Pathology System Replacement Orthodontic System Replacement Maternity System Implementation

Business Process

Web Site Content Management System

Infrastructure Network Upgrade Voice Over IP Pilot

10.0 RECOMMENDATIONS The Board of Directors is asked to comment on and approve this report as the IT Strategy for the Trust for 2009-11.